直肠类癌21例的临床特点及随访分析

Rectal carcinoid： clinical analysis of 21 cases

目的 探讨直肠类癌的临床特点、病理分型、治疗方式及其预后影响因素.方法 对2006年1月至2013年11月经内镜疑诊且经病理学检查确诊为直肠类癌而行内镜治疗和/或外科手术治疗、且有完整病历及随访资料（随访1～7.5年）的21例（男19例,女2例）患者进行回顾性分析.结果 21例患者主要表现大便习惯改变和/或因体检发现直肠肿块而入院行肠镜检查,所有病例均无类癌综合征表现.肠镜下肿块多呈浅黄色,表面光滑,直径＜1 cm者12例（57％）,肿块距肛缘＜8cm者17例（76％）.病理学检查表现多为高分化,免疫组化中NSE阳性率为较高.一年、三年生存率均为100％,五年内复发率较高（2/8）.结论 直肠指检对发现直肠类癌有重要作用.直肠类癌的预后相对较好,但有复发可能,应加强随访.影响直肠类癌预后的主要因素为肿瘤直径、浸润深度及分期.联合检测CEA、恶性肿瘤特异性生长因子、CA19-9、神经特异性烯醇化酶等指标,可提高诊断敏感性和准确性,有利于临床早期发现、早期干预.

Objective To analyze the clinical characteristics , pathological classification and therapy strategy of rectal carcinoid and its prognostic factors. Methods Forty four patients with rectal eareinoid were diagnosed and treated in Ruijin Hospital Shanghai Jiaotong University from January 2006 to November 2013, among whom 21 patients （ 19 males and 2 females） were followed-up for 1 - 7.5 years. The clinical data of these cases were retrospectively analyzed. Results The patients underwent colonoscopy because of changed bowel habits and/or abnormal digital rectal examination, none of them had carcinoid syndrome. Colonoscopy showed that most lesions presented yellowish in color and smooth in surface; the diameter of the tumor was ≤ 1.0 cm in 12 cases （57%） ; the tumors were located at the rectum within 8 cm from anal rim in 17cases （76%）; most of them were well differentiated. Immunohistochemistry demonstrated that NSE expression was highly positive. The 1 year- and 3year- survival rate were both 100%. Among 8 cases who were followed up for over 5 year, 2 relapsed. Conclusions The digital rectal examination plays a key role in detecting rectal carcinoid. Though prognosis is relatively good, we should keep close following-up to detect the recurrence. The main risk factors influencing the prognosis are tumor size, depth of invasion and clinical stage. The combination measurement of CEA,TSGF, CA19-9 and NSE will either increase the sensitivity or the specificity of early detection.